Individual
DR. JOHN M BRUCE III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1744 N MITCHELL, BOISE, ID 83704
(208) 322-1263
(208) 322-5662
Mailing address
1744 N MITCHELL, BOISE, ID 83704
(208) 322-1263
(208) 322-5662
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D1770
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0022165
—
ID
01
—
143053
UNITED CONCORDIA
—
01
—
40144
BLUE SHIELD
ID
01
—
68387
BLUE CROSS
ID
Enumeration date
07/28/2006
Last updated
07/08/2007
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